Attachment L-2 Past Performance Questionnaire.docx

ATTACHMENT L-2 – PAST PERFORMANCE QUESTIONNAIRE

When filled in, this document is source selection sensitive information iaw FAR 2.101 and 3.104

Offeror: Complete SECTION 1, and send a questionnaire to the primary customer point of contact (POC) listed on the Past Performance Information Sheet for the contract identified that is most familiar with the performance of the effort. The primary customer is considered the individual most familiar with the contractor’s performance of services at the duty location (end user).

Primary Customer POC: Complete SECTIONS 2-5 Please complete this questionnaire. Handwritten responses are sufficient. If you need more space, please attach additional pages. If you have any questions, please call the Contracting Officer, Melissa Garmoe at DSN 785-3082 or 937-255-3082. Please fax the completed questionnaire to:

DSN Fax : 986-7520/Commercial Fax : 937-656-7520. Submit 7 days prior to RFP close date.

SECTION 1: CONTRACTOR IDENTIFICATION

SOLICITATION NUMBER: ______________________________

Proposal Volume IV Tab # (Choose One): 1 2 3 4 5 6 7 8

A. Contractor

Other (specify) ______________________

C. Contract Number

D. Task Order Number (if applicable)

E. Contract Type

No

G. Period of Performance

H. Initial Contract/Task Order Cost ($)

I. Current/Final Contract/Task Order Cost ($)

J. Reasons for differences between initial contract cost and final contract costs (enter below):

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or Agency Name

B. Customer or Agency Description (if applicable)

C. Geographic description of services under this contract or task order (choose as many as apply):

|_| National Capital Region (Washington DC Metro Area) |_| San Antonio TX |_| Other locations (Please list below:)

D. Description of services/customers under this contract or task order (choose as many as apply):

|_| Department of Defense medical (Air Force, Army, Navy, TMA, OSD/HA) |_| Other Federal Agency (Provide agency name if different from above) |_| Medical (ex: hospitals, health insurance or health operations) Please describe below |_| Non-medical Please explain below:

E. Categories of Advisory and Assistance Services Provided under this contract or task order (choose as many as apply):

Management and Professional Services |_| Developing plans, programs and procedures |_| Making recommendations on organizational policy/directives |_| Accomplishing data analysis and lessons learned development |_| Drafting reports |_| Providing reviews, evaluations and recommendations on subjects of highly specialized areas of concern |_| Conducting coordination efforts with program sponsors, management and technical personnel, support organizations and outside agencies |_| Providing third party evaluations to enhance Government understanding or develop alternative positions and/or solutions to various issues/problems |_| Supplementing AFMS knowledge and expertise in the areas of (but not limited to): Subject matter expertise (ex: Government acquisition ), health care administration, project management, executive assistance, administrative assistance, emergency management, readiness Studies, Analysis and Evaluations |_| Providing recommendations on emerging technologies and their applications to enhance organizational performance |_| Reviewing medical systems performance in order to recommend solutions to identified problems |_| Providing recommendations to command staff agencies and subordinate units to strengthen medical capabilities |_| Supporting budget development, tracking and financial execution |_| Conducting studies, analyses and evaluations of medical operations to support: modernization, organizational roles and responsibilities, mission capability, force strategy, force structure options |_| Supplementing AFMS knowledge and expertise in the areas of (but not limited to): Financial analysis and consulting (ex: business process consulting) Engineering and Technical Services |_| Supporting system integration of new technologies into current medical systems |_| Reviewing and making recommendations on proposed engineering changes |_| Providing transitional Operations and Maintenance (O&M) support on new or modernized systems |_| Conducting specialized medical training |_| Supporting life-cycle management activities on fielded medical systems |_| Participating in design/technical reviews in order to make recommendations to the Government |_| Participating in system testing activities |_| Performing failure analysis and making proposed corrective actions with regard to identified medical system deficiencies |_| Supplementing AFMS knowledge and expertise in the areas of (but not limited to): data analysis, systems analysis, technical writing, engineering, instructing |_| Other, Please explain below:

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator’s Name

B. Evaluator’s Title

C. Evaluator’s Phone/Fax Number

D. Evaluator’s Mailing Address

E. Number of years evaluator worked on subject contract

SECTION 4: EVALUATION

Please confirm that your evaluation is consistent with the description of service provided in Section 2, Paragraph D, Description of Services. Indicate your level of satisfaction with each component of the contractor’s performance by circling . Please note that contractors will be given an opportunity to respond to any ratings less than Green/Satisfactory and any negative comments. Indicate your satisfaction with the overall evaluation using the scale provided below and to the right of each question. This scale is defined as follows:

E

EXCEPTIONAL – The contractor’s performance meets contractual requirements and exceeds many (requirements) to the Government’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

VG

VERY GOOD – The contractor’s performance meets contractual requirements and exceeds some (requirements) to the Government’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S

SATISFACTORY – The contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the contractor appear or was satisfactory.

M

MARGINAL – Performance does not meet some contractual requirements. The contractual performance reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

U

UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N

NOT APPLICABLE – Unable to provide a score.

The Contractor:

Demonstrated effective subcontractor management to meet performance objectives.

1. Including consideration of the offerors evaluated past performance demonstrating compliance with Utilization of Small Business Concerns and/or Small Business Subcontracting Plan.

For the overall rating, if you indicated E (Exceptional) or V (Very Good), describe specifically how the contractor exceeded contract requirements to the Government’s benefit. If you indicated M (Marginal) or U (Unsatisfactory) describe specifically how the contractor did not meet requirements. Use additional sheets if necessary.

Government Contracts Only: Has/was this contract been partially or completely terminated for default, convenience, or are there any pending terminations?

Yes

No

Default

Convenience

Pending Terminations

If yes, please explain below (e.g., inability to meet cost, performance, or delivery schedules, etc).

SECTION 5: EXECUTIVE SUMMARY

What were the contractor’s most positive aspects in the performance of the contract?

What were the contractor’s most negative aspects in the performance of the contract?

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs?

Please provide any additional comments concerning this contractor’s performance, as desired.

Evaluator’s Signature Date:

Please Fax completed questionnaire to: 937-656-7520 or DSN 986-7520. Submit 7 days prior to RFP close date.

Thank you for your prompt response and assistance!